Theories and Models in Social Marketing

Reference: Lefebvre, RC (2000). In PN Bloom & GT Gundlach (Eds.), Handbook of

Marketing and Society, Newbury Park, CA: Sage Publications.

Theories and models for social marketing abound, with little formal consensus on which
types of models for what types of social problems in what kinds of situations are most
appropriate. In defining what social marketing is, many authors include the notion of
exchange theory to link it to its marketing roots (e.g., Kotler & Roberto, 1989; Lefebvre
& Flora, 1988; Novelli, 1990). Other writers on the subject omit any mention of
exchange theory, either in their definition of social marketing or its key elements (e.g.,
Andreasen, 1995; Manoff, 1985). Elliott (1991), in a review of the exchange concepts
place in social marketing, concludes that [it] is either absent or obtuse (page 157).
Added to this confusion are other authors who refer to a social marketing theory (Gries,
Black & Coster, 1995; Tomes, 1994).

While authors such as Lefebvre & Rochlin (1997) and Novelli (1990) recognize the value
of the exchange concept in describing social marketing, both hold open the idea that
many other theoretical models may be applied in the actual development of social
marketing programs. Marketing is theory based. It is predicated on theories of
consumer behavior, which in turn draw upon the social and behavioral sciences
(Novelli, 1990, p.343). In fact, this is what happens in the practice of social marketing.
However, Walsh, Rudd, Moeykens & Maloney (1993) have noted that professional
social marketers tend to be broadly eclectic and intuitive tinkerers in their use of available
theory (p. 115). So while a review of theoretical models used in social marketing seems

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relevant to advance the field, it is also speculative as well. Many social marketers do not
report on their work in professional journals or at conferences, and of those who do, only
a few focus on the theoretical models that impacted their judgments on selection of target
audiences, questions posed during formative research studies, strategies selected, how
program elements were selected and developed, what outcomes were intended and how
they were measured.

The theories selected for review reflect the authors own experience and interaction with
a broad array of social marketers and social marketing programs. The theories also
reflect a public health bias in that most social marketing programs in this field are usually
designed by people with advanced degrees in social and behavioral science advancing
public health goals not by people with training in other fields such as business
management or economics or focusing on other issues (environment, education, justice,
for instance). As a benchmark, a review of the most commonly used theories and models
in 497 health education/health promotion articles over a two-year period found that the
health belief model, social cognitive theory, theory of reasoned action, community
organization, stages of change and social marketing were the most frequent cited ones
among the 67% of cases where theories or models were mentioned at all (Glanz, Lewis &
Rimer, 1997, p. 29). While this review highlights the most commonly used theories
among health educators, it is not necessarily reflective of which theories are utilized in
social marketing programs. Given the caveats expressed earlier, this chapter will focus
on the more commonly mentioned theories and models in social marketing programs
including: health belief model, the related theory of reasoned action,, social cognitive
theory, the transtheoretical model of behavior change (or "stages of change"), diffusion of
innovations and an overview of other models/theories mentioned or used in specific
contexts.
Health Belief Model (HBM)

As noted above, this is one of the most widely used theories among public health
practitioners, and many of its major tenets have found their way into numerous social
marketing projects. HBM was originally designed to explain why people did not

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participate in programs to prevent or detect diseases. The core components of HBM

include:

Perceived susceptibility: the subjective perception of risk of developing a particular

health condition.

Perceived severity: feelings about the seriousness of the consequences of developing

a specific health problem.

Perceived benefits: beliefs about the effectiveness of various actions that might
reduce susceptibility and severity (the latter two taken together are labeled threat).

Perceived barriers: potential negative aspects of taking specific actions.

Cues to action: bodily or environmental events that trigger action.

More recently, HBM has been appended to include the notion of self-efficacy as another
predictor of health behaviors especially more complex ones in which lifestyle changes
must be maintained over time (Strecher & Rosenstock, 1997). A wide variety of
demographic, social, psychological and structural variables may also impact an
individuals perceptions and, indirectly, their health-related behaviors. Some of the more
important ones include educational attainment, age, gender, socioeconomic status and
prior knowledge.

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HBM has been one of the more empirically studied theoretical models. A 1984 review of
this research (Janz & Becker, 1984), conducted across numerous health and screening
behaviors (for example, receiving flu shots, practicing breast self-examinations, using
seat belts, attending screening programs), found not only substantial support for the
model, but that the perceived barriers component was the strongest predictor across
studies and behaviors. Among studies that looked at sick-role behaviors (such as
compliance with medication regimens, self-help behaviors among people with diabetes),
perceived benefits proved to be the strongest predictor of engaging in health behaviors.
As social marketers make choices about the theoretical models they use in their program,
this finding of different predictors of different types of behaviors needs to be heeded so
that a particular theory or model is not misapplied.

For social marketing research and practice, HBM becomes a salient theoretical model
when addressing issues for at risk populations who may not perceive themselves as
such. Issues of fear- or anxiety-arousing messages often take place within the context of
increasing perceived threat. The HBM components of barriers and benefits seem to be
common issues addressed by many social marketing programs, especially in price and
placement decisions. And finally, though the less researched of all the components, the
cues to action component is another piece of HBM many social marketing programs
attempt to address either explicitly or implicitly.

Theory of Reasoned Action (TRA)

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TRA organizes itself around the constructs of behavioral and normative beliefs, attitudes,
intentions and behavior. An extension of TRA, the Theory of Planned Behavior (TPB)
adds the additional construct of self-efficacy ones perceived control over performance
of the behavior. In TRA, the most important predictor of subsequent behavior is ones
intention to act. This behavioral intention is influenced by ones attitude toward
engaging in the behavior and the subjective norm one has about the behavior. Attitude,
in turn, is determined by ones beliefs about both the outcomes and attributes associated
with the behavior. Subjective norms are based on ones normative beliefs that reflect
how significant referent people apprise the behavior positively or negatively. Referents
may range from ones family, to ones physician, peers or models. The TPB adds the
additional construct of perceived behavioral control that is determined by ones control
beliefs (the presence or absence of resources and impediments to engage in the
behavior) and perceived power the weighting of each resource and barrier.

In their review of TRA and TPB, Montano, Kasprzk and Taplin (1997) cannot stress
enough the importance of conducting in-depth, open-ended elicitation interviews to
identify the behavioral outcomes, referents, and facilitators and constraints that are
relevant to the particular behavior and population (p. 109). These elicitation interviews
are conducted in the early planning stages of the project and usually include 15-20
participants equally divided between those currently or planning to engage in the
behavior and those that are not. They note that TRA/TPB provide a framework for these

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interviews that programs should focus on to ascertain what beliefs should be the focus of
intervention efforts.

Social marketers often employ TRA and TPB, although it is most often implicit and
incomplete. Subjective norms and referents, for example, are often the focus of social
marketing programs (such as teen tobacco use prevention) even though the theoretical
model may not be familiar to the planners. While we see great attention given to this half
of the TRA equation, one rarely sees the same level of concern given to how to change
the attitudes toward the behavior itself. One exception was the 5 A Day for Better
Health program (Sutton, Balch & Lefebvre, 1995) where formative research discovered
that the target audience perceived people who ate 5 servings of fruits and vegetables a
day as less capable, dependable, gentle and friendly than themselves. This insight helped
the program planners design and develop materials that could counter these negative
attitudes as they fashioned the image of the program.

Social Cognitive Theory (SCT)

SCT explains behavior in terms of triadic reciprocality (reciprocal determinism) in

which behavior, cognitive and other interpersonal factors, and environmental events all
operate as interacting determinants of each other. In contrast to the previous theoretical
models, SCT explicitly recognizes that behavior is not determined by just intrinsic
factors, or that an individual is a product of their environment, but that he/she has an

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influence on what they do, their personal characteristics, how they respond to their
environment, and indeed, what their environment is. Changes in any of these three
factors are hypothesized to render changes in the others.

One of the key concepts in SCT is an environmental variable: observational learning. In

contrast to earlier behavioral theories, SCT views the environment as not just one that
reinforces or punishes behaviors, but it also provides a milieu where one can watch the
actions of others and learn the consequences of those behaviors. Processes governing
observational learning include:

Attentional: gaining and maintaining attention

Retention: being remembered

Production: reproducing the observed behavior

Motivational: being stimulated to produce the behavior

Other core components of SCT include:

Self-efficacy: a judgment of ones capability to accomplish a certain level of

performance.

Outcome expectation: a judgment of the likely consequence such behavior will

produce.

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Outcome expectancies: the value placed on the consequences of the behavior.

Emotional coping responses: strategies used to deal with emotional stimuli including
psychological defenses (denial, repression), cognitive techniques such as problem
restructuring, and stress management.

Enactive learning: learning from the consequences of ones actions (versus

observational learning).

Rule learning: generating and regulating behavioral patterns, most often achieved
through vicarious processes and capabilities (versus direct experience).

Self-regulatory capability: much of behavior is motivated and regulated by internal

standards and self-evaluative reactions to their own actions.

SCT is viewed as one of the more comprehensive efforts to explain human behavior
(Baranowski, Perry & Parcel, 1997). Its focus on reciprocal determinism and selfefficacy (the latter, as we have seen, has been adopted by other theoretical models as
well) give social marketers a strong theoretical base from which to launch environmental
interventions that complement individually-focused ones such as with the Team Nutrition
program for 4th graders (Lefebvre, Olander & Levine, 1999). A major finding of this
research project was that it was the number of different channels through which children
were exposed to Team Nutrition messages, rather than any particular component, that

Theories and models in social marketing Page 9

was most predictive of self-reported behavior change. SCT also reminds program
planners to assess the audiences perception of their ability to perform the desired
behavior, the anticipated consequences of that action, and the value they place on that
consequence. The theory also underlies many attempts to model new behaviors for our
target audience, and that attention, retention, production and motivational processes must
all be addressed for effective learning and performing of new behaviors.

The Transtheoretical Model of Health Behavior Change

This model, popularly known as stages of change, has become one of the more often
used models in social marketing programs. Although this model was being applied by
social marketing programs in the early 1990s to increase physical activity levels of
community residents (Marcus, Banspach, Lefebvre, Rossi, Carleton & Abams, 1992), its
incorporation by Andreasen as the theoretical model for Marketing Social Change (1995)
no doubt has influenced its adoption by many social marketing practitioners.

The model emerged from an analysis of leading theories of psychotherapy and behavior
change in which ten distinct processes of change were identified. These processes then
suggest certain types of interventions that will be most appropriate for moving people
through six specific stages of change. Some of the processes identified by Prochaska and
Vilicer (1997) include:

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Consciousness raising: increases awareness of the causes, consequences and cures for
a problem behavior. Feedback, education, confrontation and media campaigns are
possible intervention modalities.

Self-reevaluation: uses assessments of ones self-image with and without a particular

unhealthy behavior. Value clarification, healthy role models and imagery techniques
can help people move evaluatively.

Social liberation: increases the social opportunities or alternatives especially for

people already relatively deprived or oppressed. Advocacy, empowerment
techniques and policy changes are procedures that can be used to meet these goals.

Helping relationships; combines caring, trust, openness, acceptance and support for
health behavior change. Strategies such as relationship building, counselor calls and
buddy systems can be sources for such support.

The most popular and utilized aspect of the model are the stages themselves. They
include:

Precontemplation: people are not intending to take action in the foreseeable future,
usually measured as the next six months.

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Contemplation: people in this stage indicate that they are planning to take action
(change behavior) within the next six months.

Preparation: here people indicate that they will take action in the next month and have
a plan of action.

Action: at this stage, people have made specific behavioral changes within the past
six months.

Maintenance: people in this phase are working at preventing relapse and use many of
the processes described earlier to help them maintain their changes. This phase lasts
anywhere from 6 months to 3 years.

Termination: is described as the stage in which individuals have zero temptation and
100% self-efficacy (Prochaska & Velicer, 1997, p.39). People in this stage are sure
they will not return to their old behavior or habit.

Other concepts in the model include decisional balance (weighing the pros and cons of
changing), self-efficacy, and temptation (the role of negative affect or emotional distress,
positive social situations and craving). What the model attempts to drive home to social
marketers is that relatively few members of a target audience are ready for actionoriented programs, and that more time and energy needs to be directed to moving people
out of the earlier stages in which they are stuck through attention to other processes

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(e.g., consciousness raising, social liberation). The research of Prochaska, Velicer and
others indicates that people utilize specific processes in specific phases, and that
generally speaking, experiential processes (consciousness raising, environmental
reevaluation, self-reevaluation and dramatic relief) are most appropriate for people in the
precontemplation and contemplation stages. People in the action and maintenance phases
are more likely to use behavioral processes such as contingency management, helping
relationships, counterconditioning and stimulus control. Matching interventions to the
stage a person is in then becomes a critical factor in the effectiveness of the program to
lead to behavior change.

Prochaska and Velicer also report on a series of 12 studies looking at how pros and
cons change as people progress through the stages for a variety of health behaviors. In
all cases, the cons clearly outnumber the pros for changing for people in the
precontemplation phase. By the time one is in the contemplation phase, the number of
pros has increased and surpassed the number of cons which have not changed.
Moving from contemplation to action requires that the number of cons begins to
decrease while the pros remain steady or even increase slightly more. The
mathematical relationships between pros and cons lead the authors to conclude that
pros must increase twice as much as the cons decrease to move someone from
precontemplation to action. The implication for social marketers is that perhaps twice as
much effort should be spent raising the benefits for change as on reducing perceived costs
and barriers.

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Diffusion of Innovations

What should be one of the more important models for people who are attempting to
influence the behavior of large groups of people is diffusion of innovations. Kotler and
Roberto (1989) review diffusion of innovations research and its application to social
marketing programs. One of the first points they make in this discussion is that there are
different types of adopters in every target audience that, based on hundreds of different
studies, usually are represented in certain proportions and have unique motivations for
adopting a new behavior. These five adopter segments and their motives are:

Innovator (2.5%): need for novelty and need to be different

Early Adopter (13.5%): recognize the value of adoption from contact with innovators
Early Majority (34%): need to imitate or match up with others with a certain amount
of deliberateness
Late Majority (34%): need to join the bandwagon when they see that the early
majority has legitimated the change
Laggard (16%): need to respect traditions

In other work, Rogers (1983) has gone into great detail as to how these five segments
differ with respect to demographics, communication patterns and other variables.

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A second group of diffusion of innovation concepts centers around the determinants of

diffusions speed and extent (Oldenburg, Hardcastle & Kok, 1997). Some of these
attributes include:

Relative advantage: is the new behavior better, easier, simpler than what they
currently do?
Compatibility: does the new behavior fit into the audiences lifestyle, cultural/ethnic
beliefs and practices, self-image?
Trialability: can the behavior be tried before making a final commitment?
Communicability: can the behavior be understood clearly and easily?
Risk: can the behavior be adopted with minimal risk and uncertainty?

Rothman, Teresa, Kay and Morningstar (1983) provide the best integrated discussion of
how diffusion research influenced the development of a social marketing campaign
directed at community mental health workers. Some of their theoretical concerns that
then led to empirical investigations centered on the notion of reference group
appeals. In their case, the question was how to position the offering: should the benefit
be a bureaucratic or agency one (e.g., more efficient operations), a professional one (e.g.,
improve knowledge and skills) or a community/client one (e.g., its in their best interest).
Their review of diffusion research especially in organizational settings led them to
quickly conclude that the last appeal (community/client) was likely to be the least
effective of the three. As a consequence, they focused their project on the other two.

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Rothman et al also looked at the varying effects of high-intensity, personal selling

approaches to diffusion/marketing contrasted with a low intensity, mass
communication one. In their analysis of cost vs. utilization (adoption) patterns, the
authors concluded that for half the cost, the low-intensity approach resulted in twice
the amount of high utilization (p. 222).

Diffusion of innovations research and concepts offer a tremendous amount of insight for
social marketers to use in designing their programs, yet we see very little active
discussion of it in social marketing circles (e.g., Andreasen, 1995 does not index the
term). Diffusion of innovations has many big ideas that, when they meet constrained
budgets and short time horizons, may receive short shrift. Basic to the notion of adopter
segments, for example, is the implication that you start with one or two segments
(innovators and early adopters) and only when adoption is successful with them do you
move to the bigger numbers. Phased approaches over time are often impossible to plan
and implement when priorities change and budgets contract and expand with little
warning. Yet, other concepts related to how to make adoption happen more quickly and
efficiently can be applied in most contexts with minimal impact on resources. As was
mentioned at the beginning of this section, the diffusion model is one of the few
population-focused ones available to social marketers. While the point can be made that
ultimately behavior change happens on a individual-by-individual level, diffusion
research suggests that there are processes available to us to manage wide-spread behavior
change and not leave it to chance (c.f., Redmonds discussion of the diffusion of the
adoption of nonsmoking, 1996).

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Other theories and models

As was noted at the beginning at this chapter, there are few guides as to what theories and
models many social marketers use in planning and implementing social change programs
because not enough is written about that aspect of their work. However, several
segmentation studies have suggested other possible theories and models, applications of
social marketing in non-traditional settings offer another, and on-going social marketing
projects focused on specific health behaviors have developed their own models based on
their research findings and experience.

Morris, Tabak & Olins (1992) reported on a segmentation analysis of prescription drug
information-seeking motives among the elderly. These authors utilized the health belief
model, information-seeking research (usually subsumed under the transactional model of
stress and coping; see Lerman and Glanz, 1997), information processing models,
consumer involvement models, and a typology for consumer motivation. Slater & Flora
(1991) reviewed data from the Stanford Five-City Project and identified seven healthy
lifestyle segments. Their theoretical approach to segmentation included social cognitive
theory, the health belief model, and the theory of reasoned action. In an extension of this
work to Hispanic audiences, Williams & Flora (1995) also noted the use of several
concepts drawn from the fields of anthropology, advertising research and
communications literature.

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Murray & Douglas (1988) have examined the role social marketing could play in the
alcohol policy arena. Their analysis of the many potential ways social marketing could
be used in helping to shape social policies about alcohol (and to other issues as well)
brings to light the political science and public opinion research and theories that could
also be employed in designing certain social marketing projects.

A number of large-scale social marketing programs were conducted in community

settings in which community organization theories played a role in program development
and implementation. Some examples include the Stanford Five-City Project (Farquhar,
Maccoby & Solomon, 1984) and the Pawtucket Heart Health Program (Lefebvre, Lasater,
Carleton & Peterson, 1987). McKee (1992) discusses several different programs that
have combined social marketing with social mobilization strategies; Lefebvre (1990) has
outlined how social marketing can be used to facilitate institutionalization, or long-term
sustainability, of community-based programs; and Bryant and colleagues (1999) have
combined community organization theories and social marketing principles into a
Community-Based Prevention Marketing model. As many social marketing programs
are developed by state and local agencies, we can expect that even more work along these
lines will help push our understanding of how to effectively engage and leverage the
community to achieve social change objectives.

Piotrow, Kincaid, Rimon & Rinehart (1997) summarize their 25 years of work in
reproductive health and family planning overseas. They have developed a theoretical
framework, based on their experience, termed Steps to Behavior Change (SBC). As

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they describe it, the SBC is an adaptation of diffusion of innovations theory and the
input/output persuasion model, enriched by social marketing experience and flexible
enough to use other theories within each of the steps, or stages, as appropriate (p. 21).
The five major stages include knowledge, approval, intention, practice and advocacy,
each with three steps subsumed under it (e.g., can name family planning methods
and/or sources of supply, approves of family planning, intends to consult a provider,
chooses a method and begins family planning use, and advocates practice to others).
Other theoretical models they mention include social cognitive theory; theory of reasoned
action; social influence, social comparison and convergence theories; theories of
emotional response; and the cultivation theory of mass media.

Conclusion

Trying to depict what theories and models social marketers use in designing and
implementing programs is a daunting task. Social marketers who have advanced degrees,
and thus have studied theories, may be using this knowledge in an a priori fashion to
influence decisions from what problem to tackle, how to segment audiences, what
program objectives should be, which target audiences to choose and how to characterize
them, what questions to ask in formative research activities, how to develop program
strategies and tactics, which ones to choose, how to go about developing and testing
them, how to organize and manage the implementation/distribution process, which
message may beat resonate with the target audience, what benefits and barriers are most
in need of attention, and how do we best promote our messages, products and services (to

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list just a few key decision points). My suspicion in that in 20% of cases this is a
conscious process. To go back to Walsh et al (1993), who conducted more than 30
interviews with leading social marketers, one of their conclusions was that professional
social marketers tend to be broadly eclectic and intuitive thinkers in their use of available
theory.

Another disquieting finding is that there is little understanding of when social marketers
are using theory, models, or the results of specific research studies. There is also the
question of whether they know what is a theory versus a model. While there are
indications of models ascending to theory status (for example, people referring to
diffusion theory or stages of change theory), what appears to be happening is that
social marketers are more model-based (stages of change being the most popular at this
particular moment) and that there is some theory (model)-creep (i.e., one model or theory
is applied regardless of whether the situation or previous research supports its
application).

When behavior change theories are employed, they are used in a context of changing an
individuals behavior. Although this objective is a bottom-line focus for many social
marketers, the promise of social marketing over other approaches to social change is its
overall focus on influencing population groups to achieve social change objectives. Yet,
aside from the diffusion of innovations model, we see no evidence of population-based
theories and models being reflected in social marketing literature or discourse.

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Behavior change is a complex process and there are dozens of theories and models to
choose from to meet social marketing objectives. Too much attention seems to be given
to individual theories of change in the published literature. Social marketing is not an
alternative to individual behavior change strategies, but a process to increase the
prevalence of specific behaviors among target audiences (Lefebvre, Lurie, Goodman,
Weinberg & Loughrey, 1995). Social marketers need to expand their knowledge and use
of divergent theoretical frameworks as the situation dictates. Winett (1995) demonstrated
one approach to integrating social marketing constructs with behavioral theories. In
examining the 4Ps, he argued that various theories might be most appropriate for
thinking through each component.
Variable

Theory

Product

Diffusion theory
Stages of change

Price

Behavior analysis
Social Cognitive Theory

Promotion

Theory of Reasoned Action

Health Belief Model
Protection Motivation Theory
Social Cognitive Theory
Behavior Analysis

Place

Public Health
Ecological

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In his discussion of this integrative approach Winett also notes that most of the
behavioral theories seem to focus predominantly on the Promotion elements of the
marketing mix. His suggestion, and one echoed here, is that perhaps more attention
needs to given to theoretical models that might add insight to other elements of the
marketing process and marketing mix.

Social change is an enormous undertaking and to paraphrase a graduate advisor, The one
with the biggest toolbox wins. Using multiple theories and models that fit or explain the
behavior and situation one is challenged with, including not only the ones discussed here,
but also motivational theories to inform message development, social networks theories
to inform message dissemination, organizational development and business-to-business
marketing models to inform coalition and partnership development and management,
political theories and agenda-setting research to inform policy initiatives, cross-cultural
theories to inform international social marketing efforts, among others, are what the
profession of social marketers needs to aspire to be to meet both the personal and social
goals of doing good.

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